WASHINGTON, DC — The VA is trying to better serve its older patient population by adopting accredited geriatric emergency departments in many agency hospitals.
Sixty of the VA’s 111 emergency departments have earned Geriatric Emergency Department Accreditation (GEDA) from the American College of Emergency Physicians (ACEP). Another 11 departments are working to earn the designation in coming months, and the VA plans to expand the program to most of its hospitals over the next three years, according to a press release issued by West Health Institute. The VA is the largest healthcare system to receive system-level recognition from ACEP.
Currently, about 50% of all VHA enrollees are ages 65 and older. Between fiscal year 2023 and 2035, the number of VHA enrollees ages 85 and older is projected to increase by 73%, and the number of women veteran enrollees ages 85 and older is projected to increase by 176% during the same time frame, Scotte R. Hartronft, MD, MBA, executive director at the VHA Office of Geriatrics & Extended Care, told U.S. Medicine.
Geriatric emergency departments provide specialized support to older veterans during and after a medical emergency. The concern is that many older adults have clinical and social needs that could make them more vulnerable to medical emergencies that might not be adequately addressed in traditional emergency departments.
More than half, 54% of the about two million visits to VA emergency departments in 2022 were by veterans ages 65 and older, according to Hartronft, who added that 66.4% of admissions to VA hospitals were veterans in that age group.
“In 2019, VHA’s Office of Geriatrics and Extended Care (GEC) began a massive transformation to ensure equitable access for veterans to all GEC programs and services, programmatic support for VA medical center and Veterans Integrated Services Network (VISN) field staff, as well as to become proactive in the provision of care to aging veterans,” Hartronft wrote in an email.
The VA has partnered with the ACEP, two nonprofits dedicated to improving care for older adults (West Health Institute and The John A. Hartford Foundation) and Indiana Institute of Medical Research, one of the VA’s internal nonprofit partners to make the transition.
“We are committed to providing the best care possible for our veterans and their families wherever they live, and the expansion of our geriatric emergency department program is but the latest demonstration of our effort to enduring commitment and best practices driving innovation,” Erica Scavella, MD, assistant under-secretary for health for clinical services and chief medical officer of the VHA, said in the press release. “The response from both patients and staff to the GEDs has been very positive, and we will continue to improve and expand on the program to fit their growing and urgent needs.”
ACEP established its Geriatric Emergency Department Accreditation Program in 2018 in response to evidence that emergency departments have difficulties meeting the healthcare needs of older adults. Financial support and foundational work for the program was provided by West Health and The John A. Hartford Foundation.
With this care model, teams engage in more than two-dozen best practices covering triage, screening, evaluation, treatment, discharge, the physical environment and surroundings, as well as the coordination of essential community social and health services after discharge.
The VA effort began with a five-year strategic plan (fiscal year 2020 to 2024), which included expanding home and community-based care, modernizing systems for healthy aging, modernizing and improving facility-based care, improving access with technology and increasing geriatric workforce expertise.
In VA hospitals, geriatric emergency departments have seen improvements in care, fewer instances of polypharmacy, and more follow-up with primary-care services following a visit, according to the press release.
Based on the strategic plan’s goals, the VA is poised to become the largest Age-Friendly Health System in the U.S., Hartronft noted. In March 2020, the Office of Geriatrics and Extended Care set the aim for VHA to become the largest integrated healthcare system in the U.S. to be recognized by the Institute for Healthcare Improvement (IHI) as Age-Friendly. As of April 7, 2023, 107 VAMCs have earned Age-Friendly recognition from the IHI in a total of 217 care settings.
“The GED (Geriatric Emergency Department) movement is in full swing throughout the nation, and geriatric emergency care is becoming more and more available to seniors and their families,” Shelley Lyford, CEO and chair of West Health, said in the press release. “The VA, through its leadership and adoption of GEDs, is fueling even further expansion of this important model of care for older patients, both inside and outside the VA.”
